Friday, September 12, 2014

Will Americans Still Be Paying Off on Student Loans As Seniors?

In a GAO study titled "Inability to Repay Student Loans May Affect Financial Security of Small Percentage of Retirees," researchers reveal that a significant -- and growing -- proportion of "student loan" debt is owed by Americans aged 65 or older.  In addition to the growth in the total amount of "senior" student loan debt, from $2.8 billion in 2005 to $18.2 billion in 2013, the GAO findings include:

  • Relatively few households headed by individuals 65 or older hold student loan debt -- the number is about 706,000 households in the U.S. -- but the amount they owe may be significant, with estimates that the median debt owed is around $12,000, as compared to a median for those aged 64 and younger of $13,000.
  • Most -- about 82% -- of this debt was for the individual's own education.  It is not known whether how "old" the loans are.
  •  Older borrowers hold defaulted federal student loans at a higher rate -- and defaults can have conquences, including offsets on Social Security payments.  Generally speaking, student debts cannot be discharged in bankruptcy; however adjustments may be possible to keep the individual's monthly income above the poverty threshold.

For more discussion on the GAO report, see "Senior (Citizen) Student Debt Rising," in Inside Higher Ed by Michael Stratford.  Hat tip to Professor Laurel Terry for pointing out this new study. 

September 12, 2014 in Current Affairs, Ethical Issues, Federal Statutes/Regulations, Retirement | Permalink | Comments (0) | TrackBack (0)

Book Review--Government Regulation in Excess?

Our friend and health law/elder law rock star, Marshall Kapp, sent me a note about a book review  he authored (thanks Marshall) that appears in The Gerontologist Advance Access.  The review is of the book, The Rule of  Nobody: Saving America from Dead Laws and Broken Government by Phillip K. Howard.

You may be wondering why a blog for elderlawprofs is posting about laws and government regulations.  Three words: nursing home regulation. Although a subscription is required to read the full review, an excerpt is available for free, much of which I have reproduced here

The brilliant satirist Jonathan Swift said long ago, “Laws are like cobwebs, which may catch small flies, but let wasps and hornets break through.” (Brainy Quote, n.d.). Swift certainly did not intend that remark as a compliment to either laws or cobwebs. Nonetheless, almost all laws originate to accomplish some reasonably defensible public purpose, even though ... poorly drafted, inconsistently ... enforced, and perpetuated beyond ... their original justification ....             

In this latest project, Howard despairs that regulation in the United States has veered far from its proper function as a setter of boundaries or parameters within which individuals are empowered... (end of excerpt).

Since Marshall sent me a full copy of the book review, I can explain further what the abstract does not, how the author uses nursing home regulations as an example. Marshall describes this on page 1-2 of his review

One of the primary examples that author Howard utilizes throughout The Rule of Nobody to illustrate his constructive critique about the largely dysfunctional nature of the contemporary American regulatory situation is the overwhelmingly extensive and complex set of formal command and-control rules we have promulgated on the federal and state levels to govern the operation of nursing homes.

Marhsall offers a bit of history as to why we have so many laws and regulations for nursing homes and suggests that now is "the time to seriously contemplate smarter, rather than just bigger, regulation...." (review at page 2). He notes that the author provides examples of when the regulations don't end up benefitting the residents, with current regulations stifling innovation. (review at 3).  Marshall concludes his review with this summary

[T]he Rule of Nobody is noteworthy for the nation generally and for long-term care policy-makers particularly... Settling for being “in the ball park” is damning with faint praise, indeed. The only option for many vulnerable individuals is dependence on the benevolence of nursing home owners and workers and lawmakers’ careful guidance. Society owes them a system of oversight and influence that not only aspires to, but effectively achieves, a much loftier standard.

Another one to add to the reading list.

September 12, 2014 in Books, Current Affairs, Federal Statutes/Regulations, Health Care/Long Term Care | Permalink | Comments (0) | TrackBack (0)

Thursday, September 11, 2014

Fed Court in NY Takes Hard Line on Effect of "Partial Cure" for Medicaid Ineligibilty

Judge Geraci of the U.S. District Court, Western District of New York, is the latest judge to address an important topic in Elder Law regarding eligibility for long-term care benefits under Medicaid.  The court defines the issue as follows:  "When an uncompensated transfer of assets has been made and a [Medicaid] penalty period imposed, how does a partial return of the transferred funds affect the beginning of the penalty period?"  

In its August 2014 decision in Aplin v. McCrossen, the court addresses summary judgment motions in two separate cases that were filed on behalf of 80-year-old Florence Aplin and 85-year old Sergio Ciardi, both residents of nursing homes.  In one case, for example, the Aplin case, the transfers totaled approximately $450,000; however, approximately $76,000 was later returned by the donees. The hope of the plaintiffs was that "return" of the money would permit them to shorten their penalty periods tied to the original transfers.  This approach, when planned in advance, is a post-Deficit Reduction Act technique sometimes known in Elder Law circles as a "partial cure" (as part of "reverse half-a-loaf" gifting).

Judge Geraci denied the relief sought by the plaintiffs.  He followed the hardline approach of "nonprecedential" rulings on New Jersey disputes about partial cures, ruling that "return" of money permits the state agency to recalculate the start of the penalty period. The court decided that NY administrative rules do not conflict with federal policy and not only permit but require the state agency to, in effect, restart the penalty period on the ground that the later date is when the "applicant becomes otherwise eligible for Medicaid." This phrase is a key concept in federal Medicaid law.  The plaintiffs had argued that phrase applied only to an earlier date, from their original application. Judge Geraci concluded:

"I find no circumstances in this case which indicated that Defendants' interpretation and application of the provisions of [New York administrative directives] contravene Congress' articulated purpose in enacting the Medicaid Act -- to provide medical care, services and supplies for the financially needy.  Essentially, the assessment of an applicant's income and resources which results in a determination that such applicant has transferred resources for less than fair market value during the statutory look-back period and that an appropriate penalty period must be imposed, ensures that the applicant has not falsely impoverished himself or herself in order to qualify for medical assistance at public expenses which, by law, is undeserved."

While it is apparent that the New York federal judge was not eager to give applicants any benefit tied to partial cures on transfers, the decision also appears to approve or at least ignore what some would describe as a "perverse effect" of the New York policy.  By imposing a new, later "start date" for the ineligibility period following the return, New York can actually impose a penalty that is longer than the original penalty period for the full transfer. 

Also at issue in the case was the effect of a series of statements on the federal government's side, including the so-called "McGreal Letter" from CMS that was relied on by the plaintiffs in making the returns. (The court did not expressly address a May 2014 GAO study, where it was reported at page 28 that "[a]ccording to CMS, states can choose whether or not to consider a partial return of transferred assets on Medicaid planning.")

Should there be uniformity among the states, not just on whether but how families can seek any relief from "resource" limits set by federal law?  (The GAO study linked above indicates a range of different state-specific options are in play.) The answer to that question may depend on one's point of view.

For more background on the complex interaction between Medicaid applications, ineligibility periods triggered by uncompensated transfers, partial cure attempts and penalty start dates, see ElderLawGuy Jeff Marshall's blog post from 2011.    

September 11, 2014 in Federal Cases, Federal Statutes/Regulations, Health Care/Long Term Care, Medicaid | Permalink | Comments (0) | TrackBack (0)

Put Me In Coach!

Put me in coach---a phrase often associated with a competitive sport of some sort. We think about coaches for teams, but we need to broaden our perspective, to think about coaches in a much broader aspect:  life coaches, marriage coaches, business coaches, study coaches, and now... retirement coaches.  The NY Times ran an article, Finding an Identity Beyond the Workplace:  There's More to Retirement Than Financial Planning.  We have heard stories before of people whose identities are so intertwined with working, that they are lost when they retire.  Coaches can help those folks, and others, in finding goals for their post-work time.

This entry in the non-sport coaching field, retirement coaching, can help with goals and motivation, according to the article. "Retirement coaches ... are popular these days. The cadre has emerged in the crowded coaching field to cater to a growing number of boomers who are grappling with what’s next."  According to one expert quoted in the article, part of this need for assistance is longevity--with the years post-working stretching out longer in the future, people are looking for help in defining what to do in those years.

Here's how one retirement coach describes what they do  "[w]hen someone retires, they tend to be literally levitating with excess productivity that can’t be channeled ... We help them slowly build a basket of activities."

So what's in the basket? It could be a veritable potpourri of activities, such as "part-time work, humanitarian endeavors, entrepreneurial adventures and artistic pursuits, [as well as] ... a search for legacy and significance ...."  A significant number of clients  of one coach are described by the coach as "hav[ing] some kind of ‘give back’ gene. They want to get involved with a charitable board, or find ways to be a teacher or tutor.”

There are plays to be run in retirement coaching, just like in sports. It takes time for the recently retired to learn those plays and to be prepared for the "game."   This means the first play run will be "a self-assessment that examines values and strengths and clarifies goals, hopes and dreams for the future."  The playbook involves running numbers, too, using "retirement calculators to be sure they won’t outlive their savings."  But although a football coach can use a stop watch to see how fast a player can run the 100, it's more intangible with retirement coaching.  "[I]t’s far harder to compute in advance how to best navigate the intangibles like building a new social network and finding value in how you spend your time in retirement."

How long do you need your coach? It simply depends.  Cost does as well.  There isn't quite as much regulation for these types of coaches as there are in sports, but there still are at least two organizations, according to the article.  So why use a coach? One of the coaches is quoted: “This is a fresh track adventure ....Be patient. For the first time in your life, you need to be able to deal with white space. People get addicted to busyness. White space is the source of creativity and strategic thinking, so don’t fill up your dance card too fast.”

Since all of us are "in the game" of life and aging, we all need to think about our retirement readiness. Now we can have our own coach for that, and maybe there will be an app as well. (Please note my sports analogies are an attempt, feeble as it may be, to have a bit of fun in writing this post. Any sports analogy errors are definitely my own).

 

 

 

September 11, 2014 in Consumer Information, Current Affairs, Retirement | Permalink | Comments (0) | TrackBack (0)

Wednesday, September 10, 2014

U.S. Department of Justice Opens New "Elder Justice" Portal

The U.S. Department of Justice recently established an on-line Elder Justice Initiative, intended to assist the public, practitioners, and prosecutors with identifying and responding to all types of elder abuse.  Here are some of the highlighted resource links from the website:

Here, victims and family members will find information about how to report elder abuse and financial exploitation in all 50 states and the territories. Simply enter your zipcode to find local resources to assist you.
 
 
Federal, State, and local prosecutors will find three different databases containing sample pleadings and statutes.
 
 
Researchers in the elder abuse field may access a database containing bibliographic information for thousands of elder abuse and financial exploitation articles and reviews.
 
 

Practitioners -- including professionals of all types who work with elder abuse and its consequences -- will find information about resources available to help them prevent elder abuse and assist those who have already been abused, neglected or exploited.

September 10, 2014 in Crimes, Elder Abuse/Guardianship/Conservatorship, Federal Statutes/Regulations | Permalink | Comments (0) | TrackBack (0)

Tuesday, September 9, 2014

Intergenerational Housing--A Cool Idea From Oregon

One of the things (among the many things) I like to post about is the concept of age-friendly communities that allow a person to age in place.  Governing ran an article last month, showcasing a cool project in Oregon that provides intergenerational housing. Young and Old Find Common Ground in Oregon Housing Community explains about Bridge Meadows where elders and foster children reside in the same housing complex, where the units are provided for free to the foster parents.  "Bridge Meadows, a 36-unit apartment complex in [Portland] ... mixes incomes, generations and skill sets in a way that enlivens and enriches the lives of young and old alike." Twenty-seven of the units are for lower-income elders with the rest for those who will be foster parents (or even legal guardians) for at least 3 children within 5 years. Not only do the elders get a break on the housing costs they get to be involved!

[E]lders volunteer their time to work with the kids in the complex. For at least 100 hours per quarter, they tutor, cook, babysit, participate in outdoor activities and so forth. The complex also offers a computer room, library, public courtyard and community garden to help foster connections.

As far as the kids, the program has had a pretty significant impact. Of the "29 children ... 24 were formerly in foster care. Of those 24, just over half are either adopted or in legal guardianship and the rest are on their way to adoption or legal guardianship. In other words, they're all now part of functional families, in permanency or on their way."

The head of Bridge Meadows is pretty enthused about this model's ability to be duplicated, noting that it serves as a solution for 2 serious problems our society is facing, (1) "how to civically attend to our rapidly aging population and" (2) "how to place all the troubled kids peppering children and family services systems in the country."

The author has some concerns about effective replication but still considers this program jan important addition to the spectrum of strategies.  It is a nifty idea! More information about the project, as well as photos, are available on their website.

September 9, 2014 in Current Affairs, Housing, Other | Permalink | Comments (0) | TrackBack (0)

A Psychiatrist Shares Her Personal Journey with Grief

In Psychiatric Times, Dr. Anandhi Narasimhan, California-based and board certified in psychiatry and neurology, compares her professional and personal experiences with grieving following the death of her father.  She writes well, and in additional to offering suggestions for coping, she shares this poignant detail from her father's life, which also served to introduce me to a new and intriguing idea, "dialysis at sea."   She writes:

"My father was a distinguished scientist who placed value on education. Although he did not believe in lavishness, he always liked to present himself in a well-groomed fashion. I miss his sense of humor, and I have discovered how important such a quality can be when faced with tough times. Remembering his witty repertoire reminds me to celebrate his life.

 

The picture I have included [with her essay in Psychiatric Times] is from an Alaskan cruise my family took. We had talked about taking a cruise as a family in the past; this had been a dream of my father’s. When he was placed on regular dialysis treatments, he said, 'I guess now I won’t ever be able to go on a cruise.'

 

It wasn’t until I saw a poster advertising 'Dialysis at Sea' that I realized we could make his dream come true. With some logistical planning, transferring of medical records and such, we were able to take my father on an Alaskan cruise, an experience he both treasured and loved.When I was growing up, my father had a sort of utilitarian view of vacations—we often had to be doing and seeing things; they had to be productive. This vacation was different—it was nice to see him relax and enjoy the awesome beauty of Alaskan glaciers. His smile in the picture is how I would like to remember him: intelligent, positive, humorous, and charming."

Read more of "My Father's Influence" here

September 9, 2014 in Health Care/Long Term Care, Science, Travel | Permalink | Comments (0) | TrackBack (0)

Monday, September 8, 2014

Living In the Moment--When a Family Member Has Dementia

Have you ever considered the similarities between caregiving and improv? Probably not--who would-they certainly seem to be quite dissimilar occupations. Yet when you think about their characteristics, they are quite similar.   The website, In the Moment, which is focused on "creative ideas for training staff" lists on the landing page characteristics that apply to both, including being flexible, adaptable, courageous, spontaneous, generous, selfless and trusting.

So the idea is very intriguing. Wonder how the founder came up with this concept?  She talks about receiving a phone call almost a decade and a half ago about her mom about her dad's imminent death:

and within twenty four hours ... was on a plane flying to be with ... family and wait for ... Dad to pass away. During that time of sitting, laughing, thinking, crying and rambling -[she]...realized that the world of Improvisation was very similar to the world of caregiving and Alzheimer's disease and dementia.... [unsure] why the idea hit ... then, maybe it was divine inspiration, maybe someone was telling [her] the reason why [her] ... Dad had Alzheimer's or maybe [she] ...was sleep deprived. Probably all of the above... [Having]... attended a lot of very informative and well executed workshops and trainings... [yet] not a very good learner... [she] remember[s] sitting in a class and listening to the instructor talking about effective communication with persons with dementia."

Then inspiration struck, as she says in her own words  "[a]ll  I could think of was how tired I was of sitting . If she would just do this improv exercise it would illustrate her point more clearly and get everyone up and moving. Hmmmm...." She wrote grant applications, with this excerpt from her abstract, explaining the parallels

The rules of Improvisation parallel the “ rules “ of Caregiving for a person with Alzheimer’s. Each rule of Improv has exercises, hands on techniques to illustrate points of care. Improv itself teaches characteristics that are essential to the caregiver : listening, validation, accepting others’ realities, problem solving and creativity to name only a few. I see improvisation as another tool for caregivers and for trainers to use to create a better quality of life for each person with Alzheimer’s. I want to clarify that this this is not training of how to do Improvisation. But training that uses Improvisation to teach Alzheimer care.

The "rules" she references can be accessed here. The website also provides information about the 6 week training program, training tips, and other resources. Ultimately, the goal of this project is to "[e]Employ ... theater games with creativity exercises ... [to] provide[] caregivers with the methods to become better at what they do." 

Live in the moment--and enjoy that moment with a family member who has dementia---very good advice indeed.

 

September 8, 2014 in Cognitive Impairment, Dementia/Alzheimer’s, Games | Permalink | Comments (0) | TrackBack (0)

Anyone Can Be a Victim of a Scam...Anyone.

We all know how prevalent financial scams are, and that they are becoming more and more sophisticated. One of my colleagues, and dear friend, forwarded an email to me purportedly from his financial institution-and the email had the correct last 4 #s of his credit card!  He promptly contacted the financial institution because it looked so authentic, only to find out it was a scam.  The institution insisted there was no data breach. He promptly closed that account. I'm sure you have had similar experiences, or know someone who has (every semester I ask my students whether any of them have been victims of identity theft. Unfortunately, there is always at least one).

Governing ran a story a couple of weeks ago about state efforts to combat financial scams that target elders. The article, States Fight Financial Scams Aimed at Seniors,  quotes Mary Twomey of the National Center on Elder Abuse, that the advancement in fighting scams is happening at the state level. For example, the article indicates that in 2014 "lawmakers in at least 28 states and the District of Columbia introduced legislation addressing the issue. Some measures focus on enhancing criminal penalties. Others target caregivers who exploit elderly charges. Some require financial institutions to report suspected exploitation."

We all know the dearth of statistics makes it a challenge to really understand the magnitude of the problem.  The article quotes some studies with statistics, including a recent one from the Journal of General Internal Medicine "that found that one in 20 older adults in New York state reported that they had been financially exploited, usually by a family member, but sometimes by a friend or home-care aide."

The article also reviews some of the innovations in certain states, such as Colorado which requires training of law enforcement to recognize exploitation and abuse, with each department required to have a minimum of 1 trained officer by 01/01/2015;  and North Carolina, which allows "courts ... to freeze the assets of a defendant charged with financial exploitation of a senior or disabled adult, if the victim has lost more than $5,000."

September 8, 2014 in Consumer Information, Crimes, State Statutes/Regulations | Permalink | Comments (0) | TrackBack (0)

Tragedy on Many Fronts: South Korea Story on Aging Women Near U.S. Base

From the Associated Press in Pyeongtaek, South Korea, an especially troubling history with issues of abuse, human rights, comparative law, international relations, military accountability, and aging:

"More than 70 aging women live in a squalid neighborhood between the rear gate of the U.S. Army garrison here and half a dozen seedy nightclubs. Near the front gate, glossy illustrations posted in real-estate offices show the dream homes that may one day replace their one-room shacks. They once worked as prostitutes for American soldiers in this "camptown" near Camp Humphreys, and they've stayed because they have nowhere else to go. Now, the women are being forced out of the Anjeong-ri neighborhood by developers and landlords eager to build on prime real estate around the soon-to-be-expanded garrison.

 

'My landlord wants me to leave, but my legs hurt, I can't walk, and South Korean real estate is too expensive,' says Cho Myung-ja, 75, a former prostitute who receives monthly court eviction notices at her home, which she has rarely left over the last five years because of leg pain. 'I feel like I'm suffocating,' she says.

 

Plagued by disease, poverty and stigma, the women have little to no support from the public or the government. Their fate contrasts greatly with a group of Korean women forced into sexual slavery by Japanese troops during World War II. Those so-called "comfort women" receive government assistance under a special law, and large crowds demanding that Japan compensate and apologize to the women attend weekly rallies outside the Japanese Embassy.

 

While the camptown women get social welfare, there's no similar law for special funds to help them, according to two Pyeongtaek city officials who refused to be named because of office rules. Many people in South Korea don't even know about the camptown women."

For more of the story, see "Aging South Koreans, Once Prostitutes for U.S. Troops, Being Pushed Away from Base They Never Left."

September 8, 2014 in Current Affairs, Discrimination, Elder Abuse/Guardianship/Conservatorship, Ethical Issues, International | Permalink | Comments (0) | TrackBack (0)

Sunday, September 7, 2014

Photographer Vivian Maier: A Search for Her Heir Began with Law School Studies...

One of the challenges of teaching a course called Wills, Trusts, and Estates, is drawing diagrams to chart intestate succession in an effort to explain what happens when you don't create an estate plan (or your written estate plan has gaps or defects).   I'm always looking for good stories to incentivize my students.

That's one reason why I found "The Heir's Not Apparent" by Randy Kennedy so interesting, as the New York Times writer describes the search for missing heirs of American photographer Vivian Maier, who died in 2009, apparently without a will.   According to the article, a suit to establish the rights of a previously unknown heir, a first cousin in France,  has been filed by Virginia attorney David Deal (himself a photographer), "who said he became fascinated with Maier's life in law school and took it upon himself to try to track down an heir." 

Maier's post-death fame as a "street photographer" has created a market for her huge cache of mostly unpublished photos, part of which was purchased by an individual for $380 in a thrift auction in Chicago.  However, the suit rests on the premise that "[u]nder federal copyright law, owning a photographer's negative or a print is distinct from owning the copyright itself.  The copyright owner controls whether images can be reproduced and sold."

A 2014 documentary, Finding Vivian Maier, helps to give "color" to her interesting story of a life quietly filled with black and white photographs.

 

 

September 7, 2014 in Current Affairs, Estates and Trusts, Film | Permalink | Comments (0) | TrackBack (0)

Saturday, September 6, 2014

Our Produce Harvests are "Graying"

I claim New Mexico as one of my several "homelands."  Thus, a story about how chile farmers are confronting the aging of their work forces caught my eye.  This time of year is when the air in New Mexico grows more pungent with the smell of fresh green and red chiles roasting in road-side stands.  From the Albuquerque Journal:

"New Mexico’s chile fields are graying. The generation of farmworkers on which producers have long depended are aging out of the workforce. Farmers say local youth are loathe to take their place picking delicate green chile under a scorching sun, while tough border security and a lack of immigration reform has kept Mexican workers away.

 

Growers across the nation from Washington to South Carolina have long complained of a labor shortage, and they often blame their distance from the border with Mexico, which for decades supplied this country’s agriculture workforce. But New Mexico’s Hatch Valley – an hour’s drive from the Mexican border – is in the same boat, even though a skilled picker can make considerably more than the guaranteed state minimum wage of $7.50....

 

Juan Carlos Soto hunches over knee-high chile plants at the Adams farm in the Hatch Valley, where green fields of chile, corn and pinto beans stretch to the base of the brown Uvas mountains. He came to the U.S. illegally as a farmworker in 1984, he said, and earned citizenship through the 1986 Immigration Reform and Control Act, which granted amnesty to millions of undocumented foreign workers but did little to change the framework for legal immigration of workers going forward.

 

Soto carefully snaps long green chiles off their stems with eye-catching velocity – a skill that only experienced chile pickers have, farmers say. 'This is where I have worked my whole life,' he said, explaining that he taught his daughter to work the chile fields but adding proudly that she became a nurse. 'The youngsters want to work in the shade.'"

For more of the story, read "Chile Farmers Face an Aging Workforce." And before you dismiss this story as just about green chiles, remember that in many regions of our country, long-term care industries also depend on immigrant work forces -- another reason for getting serious about creating fair, safe avenues for legal immigration.  

September 6, 2014 in Current Affairs, International | Permalink | Comments (0) | TrackBack (0)

Friday, September 5, 2014

Technology for Caregiving-A Tool, Not A Replacement?

We have several posts about the use of technology in caregiving.  I cover it in my classes (do you?) and in particular, I want my students to think about consent, privacy and autonomy.  Several years ago, there were stories about PARO, a therapeutic interactive robot designed to resemble a baby harp seal, and its use with certain individuals, including those residing in nursing homes.  (The company website has quite a bit of information about PARO, including research papers.)  There are lots of different types of technologies available, whether assistive or monitoring. 

A recent article in the San Jose Mercury News  (and picked up by my local paper, the Tampa Bay Times) Meet Paro, a robot designed to help the elderly, reports on the results from using Paro in a local retirement community.    This article looks at the issues of ethics as well as how the use of such "socially assistive" robots results in less isolation for some residents.  The story highlights the interactions of some residents with the robot.  The article also reviews the debate regarding using such robots.  For example, Sherry Turkle, an MIT social scientist is quoted in the article offering a concern that

"faux relationships" with machines may detract from human connections..."It's not just that older people are supposed to be talking. Younger people are supposed to be listening... [and] ... [w]e are showing very little interest in what our elders have to say." Robots like Paro may offer comfort to isolated seniors, Turkle has written, but it could "make us less likely to look for other solutions for their care."

Another expert, Professor Maja Mataric,  offers a counter-view, that such robots provide both "valuable reinforcement and motivation" and notes that

While robots aren't a complete substitute for human interaction, she stressed, they may play a vital role since "there just simply aren't enough people to take care of our very large and growing elderly population." ... [and] added: "We need to think about the humane and ethical use of technology, because these things are coming."

I think this is a great topic for discussion with students.  Let me know what you think.

September 5, 2014 in Cognitive Impairment, Dementia/Alzheimer’s, Health Care/Long Term Care, Web/Tech | Permalink | Comments (1) | TrackBack (0)

Thursday, September 4, 2014

"Why Do More Women Get Alzheimer's?" It's Not Just Because We Live Longer...

George Washington Law Professor Naomi Cahn alerted us to the Washington Post coverage on new research analyzing causation factors to explain why 2/3 of all persons with Alzheimer's Disease are women. Lots of opportunities here for important classroom discussions:

"It has long been known that more women than men get the deadly neurodegenerative disease, and an emerging body of research is challenging the common wisdom as to why. Although the question is by no means settled, recent findings suggest that biological, genetic and even cultural influences may play heavy roles.....

 

Because advancing age is considered the biggest risk factor for the disease, researchers largely have attributed that disparity to women’s longer life spans. The average life expectancy for women is 81 years, compared with 76 for men. Yet 'even after taking age into account, women are more at risk,' said Richard Lipton, a physician who heads the Einstein Aging Study at Albert Einstein College of Medicine in New York.

 

The area of inquiry has been growing in part because of a push by female Alzheimer’s researchers, who have formed a group to advocate for a larger leadership role in the field and more gender-specific research. 'Scientific workforce diversity is very important because it’s much more likely to shape the research agenda,' said Hannah Valantine, the chief officer for scientific workforce diversity at the National Institutes of Health and a professor at Stanford University’s medical school.

 

Running counter to the longevity argument, Lipton’s research suggests that women who are 70 to 79 years old are twice as likely as men the same age to develop Alzheimer’s or other forms of dementia. After 80, the risk is identical and remains similar throughout the rest of life, Lipton said."

For more on emerging issues and indictors, see "Why Do More Women Get Alzheimer's?" by Frederick Kunkle.  Thanks, Naomi! 

September 4, 2014 in Cognitive Impairment, Dementia/Alzheimer’s, Science, Statistics | Permalink | Comments (0) | TrackBack (0)

LA County Nursing Home Inspections-Still Not Right

According to Kaiser Health News (KHN) Blog, Capsules, a recent audit shows that LA County's public health officials still aren't getting the nursing home inspections right. The audit, released in late August, was the latest in a series of actions regarding the complaint investigations for nursing homes in the county.  According to the article, the audit shows that

Los Angeles County public health officials inappropriately closed nursing home investigations and failed to follow state guidelines on prioritizing complaints ... [and] even after nursing home inspectors found serious problems, their supervisors downgraded the severity of findings without any explanation or without discussing the changes with the inspectors as required.

The article summarizes the troubled history with the County's record on handling inspections (the subject of prior blog posts) and notes that

[t]he most recent audit was based on a review of a small sample of cases — about 20 of the more than 3,044 that were open in March 2014 and 30 of the 1,124 cases that had been closed between July 2012 and April 2014. The audit found that five of the 30 cases were closed inappropriately without “conducting or completing the investigations...” [and] ...supervisors downgraded inspectors’ findings in 12 of the 30 closed cases, meaning that the nursing home got a less serious citation or a smaller fine. In most of those cases, there was no documentation for the reason. 

Recommendations from the audit include "that the department’s inspectors, managers and doctors improve documentation and communication to 'ensure the quality and integrity of their investigations.'" The County's response?  "[I]t agreed that the documentation was “sometimes lacking” and that improvements were necessary... [and] several changes [were already made], including putting new people in charge of the division responsible for inspections and improving the tracking and prioritization of complaints."  The County also responded, as it has previously "that the department is underfunded and 'severely understaffed.'”

The audit includes attachments with explanations regarding the auditor's recommendations, and the County's detailed response. The audit report is available here.

 

September 4, 2014 | Permalink | Comments (0) | TrackBack (0)

Wednesday, September 3, 2014

September 15 Deadline for Law Student Writing Competition on Social Insurance

 

One of my students is working on a fascinating research project and I was looking for an appropriate writing competition for him to submit his final paper.  I came across the National Academy of Social Insurance Law Student Writing Award.  The bad news is that I found it too late to benefit my student, as the deadline for submissions is Monday, September 15, 2014.  But the good news is that for those of you with law students who have already written terrific seminar papers and who are looking for a publication site, this might be the place.   

Potential topics include:  Analysis of legal and policy issues relating to any social insurance program. These issues include but are not limited to long-term care, Social Security, Social Security Disability, health insurance, Medicare, Medicaid, related public assistance and private employee benefits. Nominations of comparative and interdisciplinary work relating to social insurance protections and policies are encouraged.

Eligibility: Any substantial written work addressing topics relevant to the legal and policy issues creating, modifying, planning, and implementing social insurance programs are eligible for nomination. Papers prepared by any person(s) studying for a J.D. degree at an ABA-accredited law school. Eligible papers may not exceed 10,000 words in length, plus appropriate footnotes. Papers should observe the style specifications of and should be presented in double-spaced format on letter-size pages. All papers or articles completed before January 1, 2013 and September 14, 2014 will be considered.

Nomination Procedure: Nominations for the award can be made by a supervisor of the law student’s research paper, by an active member of the National Academy of Social Insurance, or any full-time faculty member at an ABA-accredited law school.

Our long-time friends at the Borchard Foundation Center on Law and Aging are a sponsor of the competition with the award of top prizes to take place at the NASI annual conference in Washington D.C. in January, 2015.  Perhaps this means that we plan on this opportunity for our students again in future years. (And the top award is nothing to sneeze at -- $2,500 plus an opportunity to participate in the conference with expenses paid.)

Additional information, including format and evaluation criteria are available here

September 3, 2014 in Grant Deadlines/Awards | Permalink | Comments (0) | TrackBack (0)

Resource for Researchers on Ageing in Ireland

The Centre for Ageing Research and Development in Ireland (CARDI) has created a database of statistical information for researchers interested in ageing and older people in Ireland, north and south.  AgeStats is a very user-friendly website -- and perhaps also serves as a model for survey collections in other countries? 

September 3, 2014 in International, Statistics | Permalink | Comments (0) | TrackBack (0)

Not Your Typical Phone Call

We get calls of all types, on our cell phones and for those of us who still have them, our land lines. Imagine a phone call offering you counseling on end of life options. Sound far-fetched? Not so much for some. Kaiser Health News (KHN) ran a story in late August,  Operator? Business, Insurer Take On End-of-Life Issues By Phone. The article describes a company  "Vital Decisions... [where] [a]fter sending a letter (people rarely respond) counselors essentially cold-call to offer what they describe as “nondirected” end-of-life counseling" to those who are quite ill.  The company uses social workers to make the calls, which are short (about 15 minutes). Here's what the program is designed to achieve:

to build a relationship over the phone, [with the patient] so [the patient] might be comfortable discussing his situation and his goals. Then he’ll be empowered to communicate those things with others, including his family and his doctors. He could also choose to allow the counselor to talk to his doctors or family directly. It’s paid for by insurers and federal privacy rules permit this for business purposes.

According to Vital Decision's CEO, the goal is to facilitate discussions about end of life care and empower the patient's decision-making.  "The goal is for patients to receive care in those final months that aligns with what the patient wants, even if that's the most aggressive treatment available." Some are skeptical of this phone approach because of the lack of in-person interaction and the challenges to remain neutral, which is why one expert calls for "full transparency from insurers and the company to guard against bias in the sessions."

September 3, 2014 in Advance Directives/End-of-Life, Consumer Information, Current Affairs, Health Care/Long Term Care | Permalink | Comments (0) | TrackBack (0)

Tuesday, September 2, 2014

Will "Ageing" Be a Factor In Scotland's September Vote on Independence?

Scotland is scheduled for a historic national referendum on September 18, with voters asked to vote "yes" or "no" on the question: "Should Scotland be an independent country?"  I have to think that "age" will be -- and perhaps should be -- a factor on several fronts. For example, some commentators predict younger voters may see independence as favoring jobs, or speculate that younger voters could be influenced by "celebrity" supporters. On the other hand, Scotland's population is "older" than the United Kingdom as a whole, and older citizens may realize that the existing UK pension structure may be unaffordable with a smaller pool of contributors. Examples from a recent report:

  • Although the working age population in Scotland is predicted to increase by 7% between 2010 and 2035, those of "pensionable age" will increase by 26% over the same period.
  • Scotland's growing population of "pensionable" individuals is projected to increase by 2.9 percentage points between 2010 and 2035, compared with a 1.7 percentage rise for the U.K.
  • While "life expectancy" is growing in Scotland for both men and women, periods of "not healthy" life expectancy remain significant for a number of regions, with individuals in Greater Glasgow and Clyde predicted to have, on average, as many as 10 years of less-than-healthy living circumstances.

While Scotland already has undergone a significant devolution of governance, both permitting and requiring it to shoulder greater responsibility for policy and financing, it would seem that independence holds very real consequences for "financial sustainability" on many levels, including health care and income security for older Scottish citizens. 

Commentators and friends in Scotland and the U.K. tell me it is unlikely that the ultimate vote will be in favor of independence.  Still, it will be interesting to see how older and younger Scottish citizens will vote in the referendum.

And Scotland isn't alone in its quest for identity and change in governing policies.  Consider the most recent efforts to carve out a 51st state, out of northern California.

September 2, 2014 in International | Permalink | Comments (0) | TrackBack (0)

Monday, September 1, 2014

When You Need a Passport to Visit Mom

The NY Times ran an article a few days ago about retirees who are spending the rest of their lives (or a substantial part thereof) traveling...abroad.  The August 29, 2014 article, Increasingly, Retirees Dump Their Possessions and Hit the Road focuses on the rising number of individuals who choose to travel when they retire. The article cites to statistics from the Commerce Department that "[b]etween 1993 and 2012, the percentage of all retirees traveling abroad rose to 13 percent from 9.7 percent...." As well, over a quarter of a million Social Security recipients receive their benefits at an oversees address,  close to "48 percent more than 10 years earlier...."  The article discusses the value of post-retirement travel, from checking items off one's bucket-list, to quoting experts on how today's retirees are changing the notion of a "typical" retirement.  One expert describes the travel value this way: "an extended postretirement trip can assuage a sense of loss from ending a career."  Of course, many chose domestic travel over international, but the opportunities are there-whether to see the world, or to give back to a global community. 

The article highlights a trend of sorts. Of course, not everyone may choose this path for retirement. But it does make for an interesting question when deciding where to spend the holidays when mom is now living in another country ....

Thanks to Stetson Law student Erica Munz for bringing the article to my attention.

September 1, 2014 in Current Affairs, Housing, International, Retirement, Travel | Permalink | Comments (1) | TrackBack (0)